Abstract:
INTRODUCTION:Resident operative autonomy and case volume is associated with posttraining confidence and practice plans. Accreditation Council for Graduate Medical Education requirements for graduating general surgery residents are four liver and three pancreas cases. We sought to evaluate trends in resident experience and autonomy for complex hepatopancreatobiliary (HPB) surgery over time. METHODS:We queried the Accreditation Council for Graduate Medical Education General Surgery Case Log (2003-2012) for all cases performed by graduating chief residents (GCR) relating to liver, pancreas, and the biliary tract (HPB); simple cholecystectomy was excluded. Mean (±SD), median [10th-90th percentiles] and maximum case volumes were compared from 2003 to 2012 using R(2) for all trends. RESULTS:A total of 252,977 complex HPB cases (36% liver, 43% pancreas, 21% biliary) were performed by 10,288 GCR during the 10-year period examined (Mean = 24.6 per GCR). Of these, 57% were performed during the chief year, whereas 43% were performed as postgraduate year 1-4. Only 52% of liver cases were anatomic resections, whereas 71% of pancreas cases were major resections. Total number of cases increased from 22,516 (mean = 23.0) in 2003 to 27,191 (mean = 24.9) in 2012. During this same time period, the percentage of HPB cases that were performed during the chief year decreased by 7% (liver: 13%, pancreas 8%, biliary 4%). There was an increasing trend in the mean number of operations (mean ± SD) logged by GCR on the pancreas (9.1 ± 5.9 to 11.3 ± 4.3; R(2) = .85) and liver (8.0 ± 5.9 to 9.4 ± 3.4; R(2) = .91), whereas those for the biliary tract decreased (5.9 ± 2.5 to 3.8 ± 2.1; R(2) = .96). Although the median number of cases [10th:90th percentile] increased slightly for both pancreas (7.0 [4.0:15] to 8.0 [4:20]) and liver (7.0 [4:13] to 8.0 [5:14]), the maximum number of cases preformed by any given GCR remained stable for pancreas (51 to 53; R(2) = .18), but increased for liver (38 to 45; R(2) = .32). The median number of HPB cases that GCR performed as teaching assistants (TAs) remained at zero during this time period. The 90th percentile of cases performed as TA was less than two for both pancreas and liver. CONCLUSION:Roughly one-half of GCR have performed fewer than 10 cases in each of the liver, pancreas, or biliary categories at time of completion of residency. Although the mean number of complex liver and pancreatic operations performed by GCR increased slightly, the median number remained low, and the number of TA cases was virtually zero. Most GCR are unlikely to be prepared to perform complex HPB operations.
journal_name
Surgeryjournal_title
Surgeryauthors
Sachs TE,Ejaz A,Weiss M,Spolverato G,Ahuja N,Makary MA,Wolfgang CL,Hirose K,Pawlik TMdoi
10.1016/j.surg.2014.03.006subject
Has Abstractpub_date
2014-08-01 00:00:00pages
385-93issue
2eissn
0039-6060issn
1532-7361pii
S0039-6060(14)00099-3journal_volume
156pub_type
杂志文章相关文献
SURGERY文献大全abstract::Percutaneous drainage (PCD) of abdominal infection is a therapeutic modality whose role is not well defined. Surgical literature on abdominal infection cites a cumulative mortality rate in the range of 20% to 30%, markedly dissimilar from the 80% to 90% cure rates reported in the literature on PCD. We reviewed the PCD...
journal_title:Surgery
pub_type: 杂志文章
doi:
更新日期:1984-10-01 00:00:00
abstract::We studied the role of hypoproteinemia, induced by a major burn injury, on the edema process in burned and nonburned tissues including the lung in the adult sheep. We used lymph flow (QL) and the lymph-plasma (L/P) protein ratio as indicators of the rate of fluid and protein flux across the microcirculation and into t...
journal_title:Surgery
pub_type: 杂志文章
doi:
更新日期:1984-02-01 00:00:00
abstract:BACKGROUND:In 2009, a study from our institution used retrospective data and multivariate analysis to identify 5 quantitative variables and their cutoffs that have a positive predictive value (PPV) for common bile duct (CBD) stones in gallstone pancreatitis. They also proposed a management protocol based on the scoring...
journal_title:Surgery
pub_type: 杂志文章
doi:10.1016/j.surg.2015.01.005
更新日期:2015-06-01 00:00:00
abstract:BACKGROUND:Discussion of the volume-outcome relationship in pancreatic surgery has gained increasing interest. Currently, no data describe the situation in Germany. Pursuant to a recent legislative reform, a threshold of 10 operations per year was introduced for pancreatic surgery in 2006. This study describes the situ...
journal_title:Surgery
pub_type: 杂志文章
doi:10.1016/j.surg.2012.05.011
更新日期:2012-09-01 00:00:00
abstract:BACKGROUND:Necrotizing enterocolitis is the leading case of gastrointestinal-related morbidity in premature infants. Necrotizing enterocolitis totalis is an aggressive form of necrotizing enterocolitis, which has traditionally been managed with comfort care. Recent advances in management of short bowel syndrome have re...
journal_title:Surgery
pub_type: 杂志文章
doi:10.1016/j.surg.2019.03.005
更新日期:2019-06-01 00:00:00
abstract::Myocardial high-energy phosphate and glucose-6-phosphate levels were determined in the in vivo pig heart model during ischemic arrest and reperfusion to determine the effectiveness of potassium cardioplegia in myocardial protection. Thirty-five pigs were divided into six experimental groups consisting of 2-hour normot...
journal_title:Surgery
pub_type: 杂志文章
doi:
更新日期:1979-07-01 00:00:00
abstract::Approximately 1,400 nuclear pacemakers have been implanted in patients since April, 1970, without a single battery failure; 64 of these have been implanted at the Newark Beth Israel Medical Center. All except four of the 64 pulse generators were attached to transvenous electrodes, 39 to pacing wires already in place. ...
journal_title:Surgery
pub_type: 杂志文章
doi:
更新日期:1975-12-01 00:00:00
abstract:BACKGROUND:Over the years, several modifications of the Scopinaro biliopancreatic diversion (BPD) have been proposed. This retrospective study reported the results of 15 years of follow-up after open BPD coupled with a type of transient gastroplasty (TG) and duodenal switch (DS), termed BPD-TG with DS. METHODS:Data we...
journal_title:Surgery
pub_type: 杂志文章,多中心研究
doi:10.1016/j.surg.2012.06.039
更新日期:2013-03-01 00:00:00
abstract:BACKGROUND:An immune-enhancing diet has been used to alter eicosanoid synthesis, cytokine production, and immune function in an attempt to limit the undesired immune reactions after injury from surgery. This prospective randomized study was designed to investigate the effect of preoperative immunonutrition on operative...
journal_title:Surgery
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.surg.2013.05.040
更新日期:2014-01-01 00:00:00
abstract:INTRODUCTION:Hypothermia is a well-known risk factor for postoperative complications because it prolongs the monocyte inflammatory response. The purpose of this study was to investigate whether temperature-activated ion channels (transient receptor protein channels [TRP] A1 and V1) mediate the effects of temperature on...
journal_title:Surgery
pub_type: 杂志文章
doi:10.1016/j.surg.2015.03.065
更新日期:2015-09-01 00:00:00
abstract:BACKGROUND:Groin hernia repair occasionally leads to severe chronic pain associated with entrapped or damaged nerves. Conservative treatment is often unsuccessful. Selective neurectomy may be effective, but long-term results are scarce. The authors assessed the long-term efficacy of surgical neurectomy for chronic, pos...
journal_title:Surgery
pub_type: 杂志文章
doi:10.1016/j.surg.2009.08.008
更新日期:2010-02-01 00:00:00
abstract:BACKGROUND:Interleukin 12 (IL-12) p70 is a heterodimeric protein (p35, p40 subunits) that promotes T-helper TH1-type cytokine response. In critically ill patients, after severe trauma or sepsis, IL-12 production is markedly impaired. We tested the hypothesis that deficiency of the transcription factor c-fos will increa...
journal_title:Surgery
pub_type: 杂志文章
doi:
更新日期:1999-08-01 00:00:00
abstract:BACKGROUND:After portal vein ligation of 1 side of the liver, the other side regenerates at a slow rate. This slow growth may be accelerated to rapid growth by adding a transection between the 2 sides, i.e., performing portal vein ligation and parenchymal transection. We found that in patients undergoing portal vein li...
journal_title:Surgery
pub_type: 杂志文章
doi:10.1016/j.surg.2016.05.018
更新日期:2017-03-01 00:00:00
abstract::Sixty patients with recurrent ulcers after vagotomy were treated by partial gastrectomy without revagotomy. One patient died after surgery. Seven others died of unrelated causes and one patient was lost to follow-up before 5 years, without rerecurrence having been diagnosed. Of the remaining 51 patients, one underwent...
journal_title:Surgery
pub_type: 杂志文章
doi:
更新日期:1986-05-01 00:00:00
abstract:BACKGROUND:Anastomotic leakage represents a major complication after anterior resection of the rectum. The incidence of anastomotic leakage varies considerably among clinical studies in part owing to the lack of a standardized definition of this complication. The aim of the present article was to propose a definition a...
journal_title:Surgery
pub_type: 杂志文章,评审
doi:10.1016/j.surg.2009.10.012
更新日期:2010-03-01 00:00:00
abstract::The possibility of vagal reinnervation to intrasplenic islet grafts was examined by measuring portal insulin response to electric stimulation of the dorsal vagus nerve in autografted dogs. Grafted islets responded appropriately to an exogenous cholinergic agent given intravenously. However, no insulin secretory respon...
journal_title:Surgery
pub_type: 杂志文章
doi:
更新日期:1986-12-01 00:00:00
abstract::We reviewed 137 patients with colon injury and applied multiple regression analysis to determine the influence of various parameters on colon-related infection. The complications of intra-abdominal abscess, wound infection, and peristomal abscess occurred in 25% of patients. The mortality rate was 3.6%, and four of fi...
journal_title:Surgery
pub_type: 杂志文章
doi:
更新日期:1986-10-01 00:00:00
abstract:BACKGROUND:Operative injury to the body from all procedures causes a stereotypical cascade of neuroendocrine, cytokine, myeloid, and acute phase responses. This response has been examined commonly by the use of cortisol, interleukin-6 (IL-6), white cell count, and C-reactive protein (CRP). We aimed to determine which m...
journal_title:Surgery
pub_type: 杂志文章,评审
doi:10.1016/j.surg.2014.09.009
更新日期:2015-02-01 00:00:00
abstract::Serum contains a 90,000 molecular weight glycoprotein that exhibits insulin-like activity on adipocytes, skeletal muscle, and fibroblasts in tissue culture; however, this protein is physicochemically and immunochemically distinct from insulin and presently is termed "nonsuppressible insulin-like activity ("nsilA)." Th...
journal_title:Surgery
pub_type: 杂志文章
doi:
更新日期:1976-11-01 00:00:00
abstract::An occlusion of the superior vena cava by a tumor thrombus extending into the right atrium was diagnosed in three patients with a follicular thyroid cancer. All patients showed the typical clinical picture of the superior vena cava syndrome. A right parasternal thoracotomy was performed for preparation of the major ve...
journal_title:Surgery
pub_type: 杂志文章
doi:
更新日期:1990-12-01 00:00:00
abstract:BACKGROUND:Hepatopancreatobiliary surgery has a high incidence of postoperative morbidity, including incisional surgical site infection. Although several studies showed that subcuticular sutures reduced incisional surgical site infection in other fields of surgery, their impact on hepatopancreatobiliary surgery remains...
journal_title:Surgery
pub_type: 杂志文章
doi:10.1016/j.surg.2018.04.002
更新日期:2018-08-01 00:00:00
abstract:BACKGROUND:Conventional parathyroidectomy involves a bilateral neck exploration with the patient under general anesthesia with a thorough search for all parathyroid tissue. The purpose of this study was to assess the efficacy and safety of unilateral neck exploration under local anesthesia in patients with asymptomatic...
journal_title:Surgery
pub_type: 杂志文章
doi:10.1067/msy.2099.101834
更新日期:1999-12-01 00:00:00
abstract::In this study a smooth muscle cell seeding technique was developed and evaluated in biodegradable vascular grafts in rats. Cultured smooth muscle cells (3.5 to 5 X 10(6) in 0.1 ml whole blood) were seeded by means of a one-step preclotting technique in microporous, compliant, biodegradable vascular grafts (internal di...
journal_title:Surgery
pub_type: 杂志文章
doi:
更新日期:1988-02-01 00:00:00
abstract:BACKGROUND:Improvement of angina pectoris symptoms after cholesterol lowering has raised questions as to the underlying mechanisms. METHODS:Rabbit experiment: We compared arterial blood samples from New Zealand White cholesterol-supplemented rabbits (n = 6) with nonsupplemented rabbit samples (n = 4) in a closed-loop ...
journal_title:Surgery
pub_type: 杂志文章
doi:10.1067/msy.1998.90944
更新日期:1998-10-01 00:00:00
abstract:BACKGROUND:The surgical workforce particularly in rural regions needs novel approaches to reinforce the skills and confidence of health practitioners. Although conventional telementoring systems have proven beneficial to address this gap, the benefits of platforms of augmented reality-based telementoring in the coachin...
journal_title:Surgery
pub_type: 杂志文章
doi:10.1016/j.surg.2019.11.008
更新日期:2020-04-01 00:00:00
abstract::Fourteen infants with extensive short-bowel syndrome (SBS) were treated from 1978 through 1987 at the Children's Hospital, Columbus, Ohio. Extensive SBS was defined as a residual jejunoileum that was 25% or less than the normal expected length for each infant's gestational age. The cause of the SBS included gastroschi...
journal_title:Surgery
pub_type: 杂志文章
doi:
更新日期:1989-02-01 00:00:00
abstract:BACKGROUND:Laparoscopic ultrasound (LUS) is a method of intraoperative bile duct imaging that can be used prior to any potentially hazardous dissection. The purpose of this study was to determine whether LUS could permit safe laparoscopic completion of difficult cholecystectomy (LC) cases and to assess whether its use ...
journal_title:Surgery
pub_type: 杂志文章
doi:10.1016/j.surg.2013.04.041
更新日期:2013-10-01 00:00:00
abstract::We investigated the effects of infusion of somatostatin (200 and 500 ng/kg/min) on central hemodynamics and renal blood flow measured with radioactive microspheres. At the lower dose infusion rate somatostatin did not alter any hemodynamic parameter, but at 500 ng/kg/min somatostatin caused minor transient bradycardia...
journal_title:Surgery
pub_type: 杂志文章
doi:
更新日期:1985-03-01 00:00:00
abstract:BACKGROUND:Failure to achieve primary fascial closure (PFC) after damage control laparotomy is costly and carries great morbidity. We hypothesized that time from the initial laparotomy to the first take-back operation would be predictive of successful PFC. METHODS:Trauma patients managed with open abdominal techniques...
journal_title:Surgery
pub_type: 临床试验,杂志文章,多中心研究
doi:10.1016/j.surg.2014.04.019
更新日期:2014-08-01 00:00:00
abstract:BACKGROUND:The gastrointestinal mucosa is an important route of entry for microbial pathogens. The immune cells of Peyer's patch (PP) compartments contribute to the active immune response against infection. Although local anesthetics are widely used in clinical practice, it remains unclear whether local anesthetics suc...
journal_title:Surgery
pub_type: 杂志文章
doi:10.1016/j.surg.2010.03.024
更新日期:2011-01-01 00:00:00